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Implementing Rehabilitation Programmes: Briefing to the Joint Monitoring Committee on Improvement of quality of life and status of Children, Youth and Disabled Persons.

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Director: Chronic Diseases, Disabilities and Geriatrics. Department of Health. 30 May 2008 ... Geriatrics. Rehabilitation _at_ old age homes. Facilities Planning ... – PowerPoint PPT presentation

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Title: Implementing Rehabilitation Programmes: Briefing to the Joint Monitoring Committee on Improvement of quality of life and status of Children, Youth and Disabled Persons.


1
Implementing Rehabilitation Programmes Briefing
to the Joint Monitoring Committee on Improvement
of quality of life and status of Children, Youth
and Disabled Persons.
  • Sandhya A Singh
  • Director Chronic Diseases, Disabilities and
    Geriatrics
  • Department of Health
  • 30 May 2008

2
Introduction
  • Access to health care creates equalization of
    opportunities.
  • Comprises various components including
    rehabilitation.
  • Prevention is integral all levels
  • Rights-based service delivery
  • Barriers experienced are noted
  • Persons with Disabilities are within health
    system
  • Implement policy to improve quality of lives.

3
The outline of the presentation..
  • Underlying policy
  • Policy must benefit those in greatest need
  • Disability and rehabilitation exclusion
  • Comprehensive rehabilitation service
  • DOH creating access to rehabilitation services
  • Barriers are noted
  • Conclusion

4
Legislation and Policy underlying service
delivery
  • National Context
  • National Health Act (No 61 of 2003)
  • Mental Health Care Act (No 17 of 2002)
  • National Rehabilitation Policy
  • Free Health Care Disabled People at Facility
    Level.
  • Child Youth and Adolescent Mental Health Care
    Policy Guidelines.
  • INDS (1997)

5
International Context.
  • U N Convention on the Rights of Persons with
    Disabilities
  • Translate into the proposed National Disability
    Policy Framework
  • Articles
  • Cross Cutting eg Prevention, Access to
    Information
  • Health, Rehabilitation and Habilitation.

6
Policy must access those in greatest need.
  • DOH recognizes a rights-based definition
  • Supports the Cabinet proposal (1995)
  • Disability is the loss of opportunity due to
    barriers
  • Compliant with the ICF
  • 2001 Census Reported impairment
  • Impairment based
  • How do we measure barriers?

7
In attempting to benefit those in need..
  • Disability results in further Exclusion
  • Poverty
  • Difficulty accessing basic services in general.
  • Difficulty accessing rehabilitation
  • Vulnerable to disease
  • Women
  • Mothers or caregivers
  • With disabilities
  • Low levels of literacy

8
Comprehensive Rehabilitation
  • Various levels of prevention
  • Goal-orientated
  • Time limited process
  • Enable person to reach optimal functioning
  • Social integration

9
CBR is a Philosophy first
  • Based on CBR as a Philosophy
  • Person with Disability/Family and/or Caregiver is
    central to all decision making processes
  • Rehabilitation occurs with and not for
  • NDPF recommends the development of inter sectoral
    policy on CBR

10
What comprehensive rehabilitation includes.?
  • Primary Prevention
  • General Public
  • Information must be in an accessible mode and
    format
  • Healthy lifestyles
  • Prevent Onset
  • Secondary Prevention
  • Early Identification and Intervention
  • Referral sytems
  • ECD
  • Inter Sectoral Collaboration

11
Comprehensive rehabilitation.
  • Tertiary prevention Rehabilitation
  • Inter sectoral and Multi-Disciplinary
  • All levels of care
  • Provision of Assistive Devices,Technology,Surgery
  • Provinces vary in terms of their capacity to
    issue
  • Eg November 2007
  • Gauteng
  • 1717 manual wheelchairs
  • Eastern Cape
  • 1453 wheelchairs

12
Changing profile observed
  • Increasing demand from persons with acquired
    impairment and disabilities
  • HIV and AIDS
  • Neuro-anatomical,sensory
  • Diseases of lifestyle
  • Stroke
  • Diabetes related
  • Amputations
  • Blindness

13
DOH creating access to rehabilitation toward
improving quality of life..
  • DOH Strategic Plan 2008/09-2010/11
  • Free Health Care at Facility level
  • Accessibility of health facilities
  • Physical
  • Communication
  • Access point of public transport to facility
  • Waiting period for wheelchairs
  • Policy
  • Orientation and Mobility Services

14
Creating Access..
  • Intra Sectoral Collaboration eg
  • MCWH
  • Foetal Alcohol Syndrome
  • Care and Support
  • Step down Facilities
  • Geriatrics
  • Rehabilitation _at_ old age homes
  • Facilities Planning
  • Building accessibility

15
Access..
  • Inter Sectoral Collaboration
  • DOE
  • Collaboration on implementing WP 6
  • ECD
  • DOSD
  • Disability Grant Assessment
  • ECD
  • RAF
  • Propose that assessment tool for serious injury
    is based on the concept of ICF impact of injury

16
Access..
  • Information/ Education
  • SABC/ local radio education programmes
  • Basic sign language and interpretation training
    for health service providers
  • Provinces exploring training of Deaf persons as
    VCT counselors
  • Making HIV AIDS education accessible to all.
  • Community Service for therapists
  • Access to services by many communities for the
    first time.

17
Access.
  • Economic Development
  • Persons with Disabilities to repair wheelchairs
  • Located at wheelchair repair sites
  • Receive remuneration in various forms
  • SLAs with NGOs
  • Paid directly

18
When there are barriers to access
  • Within the health system
  • Services at a local level?
  • Lack of or limited resources
  • Recruitment retention of Therapists
  • Transport to reach patients in the community
  • Budget
  • Assistive Devices/ Other technology
  • Consumables Nappies, linen savers

19
Barriers
  • When resources exist..
  • Limited space available
  • Provincial budget system
  • Centralized vs decentralized
  • Difficulty to sustain
  • NGO initiated integrate into the health system
  • priority competing with other programees
  • Difficulty to apply systems to rehabilitation
    seen as something different outside health

20
Barriersexperienced by the person
  • No support/assistance
  • Children
  • Adults and older persons who are not
    independently mobile.
  • Public Transport
  • Cost
  • Basic availability
  • Models of service delivery are inappropriate
  • do for
  • CBR common Understanding???

21
Thank You.
  • Sandhya Singh
  • SinghS_at_health.gov.za
  • Cell 0828825012
  • Tel (w) 012 312 0472/3

22
In conclusion.
  • Rehabilitation often provided under very
    difficult circumstances
  • Rural doesnt mean poor quality
  • Commitment by service providers must be
    recognized.
  • HOWEVER!
  • Recognize GAPS!
  • Accessibility to rehabilitation by all
    communities-EQUITY
  • Assistive Devices/technology
  • Reinforcing Human Rights approaches
  • Strive to create optimal environment
  • We must work together.
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